Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a rise in serum creatinine from baseline [X] mg/dL to [Y] mg/dL, accompanied by new-onset proteinuria and/or hematuria. Recent donor-specific antibody (DSA) screening is positive. No history of medication non-adherence or recent nephrotoxic exposure. Symptoms include [fluid retention/decreased urine output/fatigue].
Clinical Examination Findings
Patient appears [well-appearing/ill]. Vital signs: BP [X/Y] mmHg (noting potential hypertension secondary to graft dysfunction). Physical exam reveals peripheral edema ([+1/+2/+3]), jugular venous distention, and tenderness over the renal graft site. No signs of systemic infection.
Treatment Protocol
Initiate induction therapy for active AMR: Plasmapheresis (PLEX) [X] sessions, IVIG [Y] g/kg, and pulse corticosteroids. Consider Rituximab [Z] mg if refractory. Optimize maintenance immunosuppression (Tacrolimus/Mycophenolate/Prednisone). Monitor DSA titers and graft function daily.